30/01/2023 08:15

What are the penalties for the act of health insurance fraud in Vietnam?

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Currently, there are many cases of fraud to take advantage of health insurance. So what is the penalties for this behavior? “Ha Giang-Long An, ”Vietnam

Hello,Lawnet would like to answer your questions as follows:

1. What is health insurance fraud?

According to the Law on Health Insurance 2008 amended in 2014, Health insurance is a form of compulsory insurance which is implemented by the State to look after the health of the insured according to this Law for non-profit purposes..

Health insurance fund means a financial facility set up from health insurance premium payments and other lawful collections, which is used to cover costs of medical care for the insured, managerial costs of health insurance institutions and other lawful costs related to health insurance.

Health insurance fraud is an act where the offender performs deceitful tricks such as:

- Forging medical records or prescriptions, falsely increase the quantity or types of medicines, medical equipment, services, treatment costs and other costs that are not incurred by the patient;

- Forging documents, health insurance cards or using fake, revoked, falsified health insurance cards, health insurance cards of other people in order to illegally obtain health insurance benefits.

2. What are the administrative penalties for the act of health insurance fraud?

Pursuant to Decree 12/2022/ND-CP and Decree 117/2020/ND-CP, the administrative penalties for health insurance fraud are as follows:

Violations	Frame	Fine levels
Forging medical records or prescriptions that are not incurred by the patient	Violations that earn a profit below 1 million VND	200.000 - 500.000 VND
	Violations that earn a profit of from 1 to 2 million VND	500.000 - 01 million VND
	Violations that earn a profit of from 2 to 5 million VND	01 - 02 million VND
	Violations that earn a profit of from 5 to 10 million VND	03 - 05 million VND
	Violations that earn a profit of from 10 to 15 million VND	05 - 10 million VND
	Violations that earn a profit of from 15 to 25 million VND	10 - 15 million VND
	Violations that earn a profit of from 25 to 50 million VND	15 - 20 million VND
	Violations that earn a profit of from 50 to 80 million VND	20 - 25 million VND
	Violations that earn a profit above 80 million VND	25 - 30 million VND
Falsely increasing the quantity or types of medicines, medical equipment, services, treatment costs and other costs that are not incurred by the patient	Violations that earn a profit below 1 million VND	500.000 - 01 million VND
	Violations that earn a profit of from 1 to 3 million VND	01 - 03 million VND
	Violations that earn a profit of from 3 to 5 million VND	03 - 05 million VND
	Violations that earn a profit of from 5 to 10 million VND	05 - 10 million VND
	Violations that earn a profit of from 10 to 20 million VND	10 - 20 million VND
	Violations that earn a profit of from 20 to 30 million VND	20 - 30 million VND
	Violations that earn a profit of from 30 to 40 million VND	30 - 40 million VND
	Violations that earn a profit of from 40 to 50 million VND	40 - 50 million VND
	Violations that earn a profit of from 50 to 60 million VND	50 - 60 million VND
	Violations that earn a profit above 60 million VND	60 - 70 million VND

3. What are the penalties for the act of health insurance fraud?

According to Article 215 of the Criminal Code 2015, a person who commits any of the following acts and to illegally obtain an amount of health insurance payout of from VND 10,000,000 to under VND 100,000,000 or causes damage assessed at from VND 20,000,000 to under VND 200,000,000 shall have could be criminally prosecuted for health insurance fraud.

The penalties include:

Violations	Penalties
A person who commits any of the following acts and to illegally obtain an amount of health insurance payout of from VND 10,000,000 to under VND 100,000,000 or causes damage assessed at from VND 20,000,000 to under VND 200,000,000: - Forging medical records or prescriptions, falsely increase the quantity or types of medicines, medical equipment, services, treatment costs and other costs that are not incurred by the patient; - Forging documents, health insurance cards or using fake, revoked, falsified health insurance cards, health insurance cards of other people in order to illegally obtain health insurance benefits.	A fine of from VND 20,000,000 to VND 100,000,000 or a penalty of up to 02 years' community sentence or 03 - 24 months' imprisonment:
This offence committed in any of the following circumstances: - The offence is committed by an organized group; - The offence is committed in a professional manner; - The amount of health insurance payout illegally obtained is from VND 100,000,000 to under VND 500,000,000; - The property damage caused by the offence is assessed at from VND 200,000,000 to under VND 500,000,000; - The offence involves the use of deceitful methods; - Dangerous recidivism.	A fine of from VND 100,000,000 to VND 200,000,000 or a penalty of 01 - 05 years' imprisonment
This offence committed in any of the following circumstances: - The amount of health insurance payout illegally obtained is ≥ VND 500,000,000; - The damage is ≥ VND 500,000,000.	A penalty of 05 - 10 years' imprisonment

- This English translation is for reference purposes only and not a definitive translation of the original Vietnamese texts;
- Articles may be compiled from a variety of sources;
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Nhu Y

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Key word: health insurance in Vietnam | health insurance fraud in Vietnam | administrative penalties in Vietnam |